TECHNIQUE

Windows Impression Technique for Anterior Fibrous Maxillary Ridges

Syed Murtaza Raza Kazmi,1 Sameer Quraeshi1 and Zahid Iqbal2

ABSTRACT
This article is aimed at modifying conventional windows impression technique for making impression of edentulous flabby maxillary ridges. Vinyl Polysiloxane (VPS) impression material was preferred over conventionally used metallic oxide, due to ease of use and dimensional accuracy. The authors used VPS putty consistency on the periphery and regular body for the whole impression. This combination of material consistency gives selective pressure impression. More over the window over the flabby area give the very mucostatic impression of the displaceable area. The authors found the proposed technique superior over Watsons technique in regards of convenience, time consumption, comfort of the operator and patient. Key words: Windows impression, flabby ridge, selective pressure impression technique, Anterior Maxilla. How to cite this article: Kazmi SM, Quraeshi S, Iqbal Z. Windows Impression Technique For Anterior Fibrous Maxillary Ridges. J Dow Uni Health Sci 2013; 7(2): 76-79.

INTRODUCTION
Different techniques have been proposed for making impressions of the edentulous arches. 1,2 These techniques can be broadly divided into three classes according to pressure applied i.e., the mucostatic technique (non-displacive),3 the muco-compressive (displacive) technique,4,5 and selective pressure technique.6 Selection of a specific impression technique for a particular patient depends on the nature of the mucosa overlying the edentulous ridge.2 Making impressions is difficult when residual alveolar ridge is flat, knife edge, flabby and/or having unfavorable muscle attachment.7 Management of flabby (highly displaceable) ridge poses challenge to the operator.7-9 It is most commonly present in the premaxillary region.10 The clinically significant problems associated with flabby maxillary ridge are that of insufficient retention/stability of the maxillary complete denture, discomfort and occlusal
1 Department of Prosthodontics, Dr. Israt-ul-Ebat Khan Institute of Oral Health Science, Dow University of Health Sciences Karachi. Pakistan. 2 Department of Prosthodontics, FMH Medical and Dental College, Lahore, Pakistan. Correspondence: Dr. Syed Murtaza Raza Kazmi, Department of Prosthodontics, Dr. Israt-ul-Ebat Khan Institute of Oral Health Science, Dow University of Health Sciences Karachi. Pakistan. Email: murtazakazmi@hotmail.com
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disharmony which are caused by tissue recoil in the flabby ridge area.8,11 Many authors have proposed selective pressure impression techniques for flabby ridge impressions by modifying custom tray by window cut through, vent holes, spacer or combination.12-17 Some clinicians try to solve this problem by chair side reline. Relining in such cases further displaces flabby tissue.8 Liddlelow13 used two impression materials, plaster of paris and zinc oxide eugenol in custom tray. Osborne14 proposed a technique in which he used two impression trays to record normal and flabby tissue separately and later related them intra-orally. Watson15 introduced the Window impression technique. In this technique he made a window in the custom tray. This window or opening was made in the area of flabby tissue. Watt and McGregor16 proposed initial impression with fluid/mucostatic impression material. Then make impression of plaster cast with impression compound in custom tray and later adjust it in patients mouth. McCord and Grant6 recommended use of zinc oxide eugenol or regular body poly vinly siloxane impression on custom tray. Then cut through of wash material and tray equivalent to flabby area. Lynch and Allen17 revisited technique proposed by Watt and McGregor. They used impression compound to modify the custom tray and zinc oxide eugenol wash impression. In contemporary dental practice elastomeric impression materials especially Vinyl Poly siloxane (VPS) impression materials are commonly used.6,12,18,19 These impression material produce good results as compared to zinc oxide eugenol impression paste, irreversible

Journal of the Dow University of Health Sciences Karachi 2013, Vol. 7 (2): 76-79

Windows impression technique for anterior fibrous maxillary ridges Figure 5: Periphery of the maxillary arch with putty consistency vinly polysiloxane (PVS) Empress Std, 3M ESPE. About 1mm putty is removed from the periphery for the regular body wash impression material.

Figure 1: Make the primary impression of the maxillary arch with putty consistency vinly polysiloxane (PVS) Empress Std, 3M ESPE.

Figure 2: Pour the cast, with compatible dental plaster.

Figure 6: Load regular body polyvinylsiloxane (Imprint II Garant Monophase,3M) on the impression tray, both on the posterior segment and anterior loop

Figure 3: Fabricate the initial tray with autopolymerizing acrylic without covering the area marked with indelible pencil.

Figure 7: Load regular body PVS Imprint II Garant Monophase, 3M, on one single layer 2x2 gauze.

Figure 4: Made multiple 4-5mm combs like grooves on the border area of the tray for the mechanical locking of the impression material.

Figure 8: Retrieve the impression tray after the last coating of regular body PVS is set.

Journal of the Dow University of Health Sciences Karachi 2013, Vol. 7 (2): 76-79

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Syed Murtaza Raza Kazmi, Sameer Quraeshi and Zahid Iqbal

hydrocolloid and impression plaster.20 Metallic oxide impression paste tends to stick to the dry mucosa lining.6 While impression plaster is difficult to handle and pour.21 Therefore, a modified window impression technique is described which uses different viscosity VPS impression material. This is convenient to practice and comfortable for the patient. TECHNIQUE 1. Make the primary impression of the maxillary arch with putty consistency vinly polysiloxane (VPS) Empress Std, 3M ESPE, Figure 1. 2. Pour the cast, with compatible dental plaster, Figure2. 3. Mark the flabby tissue area on the cast with indelible pencil. 4. Fabricate the initial tray with autopolymerizing acrylic without covering the area marked with indelible pencil, Figure 3. 5. Check the finished initial tray on patients mouth. Do any needful modification. 6. Tray should be 1-2mm short of mucogingival fold and 1mm away from the flabby tissue. 7. Made multiple 4-5mm combs like grooves on the border area of the tray for the mechanical locking of the impression material. Additionally the tray adhesive for chemical bonding of the impression material to the tray, Figure 4. 8. Mix putty consistency VPS (Express STD, 3M) and make it about 4mm thick rope and adapt it on the facial flange from one tuberosisty to the other and also on the post dam area. 9. Insert the loaded tray in the patients mouth and perform necessary border molding. 10. Retrieve the tray after the VPS is set. Check for any over or underextension. Perform any needful correction. No putty material should be on the intaglio surface of the tray. 11. About 1mm putty is removed from the periphery for the wash impression, Figure 5. 12. Paint tray adhesive on the intaglio surface of the tray. Wait for 5-10minute as per the recommendation of the manufacturer. 13. Load regular body Vinyl Polysiloxane (Imprint II Garant Monophase, 3M) on the impression tray, both on the posterior segment and anterior loop, Figure 6. 14. Seat the impression tray in the patients mouth. 15. Perform border molding.
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16. Load regular body VPS on one single layer 2x2 gauze, Figure 7. 17. Apply regular body VPS through syringe on the exposed flabby tissue and spread it with gentle air pressure. Repeat it till all the exposed area is wet with light body VPS. 18. Place these gauzes one by one on the exposed tissue and also touching the initial tray all around. This will give bonding of gauzes with the initial tray. 19. Retrieve the impression tray after the last coating of regular body VPS is set, Figure 8. 20. Disinfect and box the impression and pour it in type III dental stone. SUMMARY: A modified impression technique using different viscosities of VPS impression material is presented. There is special consideration to the choice of impression material as well as to the design of custom tray to ensure that no pressure is exerted on the flabby ridge. The use of different consistency of the impression material give selective pressure impression, window makes the impression over the flabby area more mucostatic. Selection pressure impression helps in gaining retention through peripheral seal. The window cut-through prevents the displacement of the flabby tissue hence ovoid tissue recoil and loss of retention.

REFERENCES
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Windows impression technique for anterior fibrous maxillary ridges

Basker RM, Davenport JC. Prosthetic treatment of the edentulous patient. 4th ed. Oxford: Blackwell; 2002.p.172-202. Allen F. Management of the flabby ridge in complete denture construction. Dent Update 2005;32:524-8.

15 Watson RM. Impression technique for maxillary fibrous ridge. Br Dent J 1970;128:552. 16 Watt DM, MacGregor A. Designing complete dentures. 2nd ed. Bristol: IOP Publishing ; 1986.p.24-5. 17 Lynch CD, Allen PF. Management of the flabby ridge: re-visiting the principles of complete denture construction. Eur J Prosthet Rest Dent 2003;11:145-8. 18 Lynch CD, Allen PF. Quality of written prescriptions and master impression for fixed and removable prosthodontics: a comparative study. British Dent J 2005;198:17-20. 19 Lynch CD, Allen PF. Quality of communication between dental practitioners and dental technicians for fixed prosthodontics in Ireland. J Oral Rehab 2005;32:901-5. 20 Woelfel JB. Contour variations in impressions of one edentulous patient. J Prosthet Dent 1962;12:229-54. 21 Freeman SP. Impressions for complete dentures. J Am Dent Assoc 1969;73:1173-8.

10 Kelly E. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. J Prosthet Dent 1972;27:140-50. 11 Lytle RB. The management of abused oral tissues in complete denture construction. J Prosthet Dent 1957;7:27-42. 12 Tan KM, Singer MT, Masri R, Driscoll CF. Modified fluid was impression for severely resorbed edentulous mandiblar ridge. J Prosthet Dent 2009;101:279-82. 13 Liddelow KP. The prosthetic treatment of the elderly. Br Dent J 1964;117:392-4. 14 Osborne J. Two impression methods for mobile fibrous ridges. Br Dent J 1964;117:392-4.

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